Monday, May 23, 2005

An odd place for a telephone booth

I was sitting in my office, working on a yearly summary report for a grant. In such reports, it is customary to report on what you have done the previous year and, most importantly, to paint a glowing picture to the granting agency (in this case, the Army) of how much fantastic progress has been made on the funded project and how well-spent its money had been, so that they continue to fund the remaining years of the project. While I was typing away and cutting and pasting various figures into the document, I felt the call of nature. It's not surprising, given that the verbiage that I was introducing into the report was not unlike one of the end products of answering said call (which is probably why such tasks seem to stimulate certain biological functions in me). I tried to ignore the need for a while, wanting to finish the section I had been working on first, but the urge became steadily more insistent. Biology can only be denied for so long before it has a way of forcing its will to be done.

I headed towards the bathroom nearest my office, thankful that the urge hadn't hit me while I was in the operating room.

Entering the nearest stall, I prepared to do what my colon was demanding of me when, eminating from the stall next to me, I heard it. No, it wasn't the rude noises common to such facilities, nor was it the flush of a toilet. It was this (paraphrased from memory, of course; I don't carry tape recorders into the john with me, at least not routinely):

"Well, I realize that that regimen will really knock him for a loop. He'll be neutropenic for quite a while, and he might even need to be admitted. On the other hand, he's failed first-line therapy, and this is probably your best next option."

I recognized the voice. It was one of our medical oncologists (whom I'll call "Dr. X"). In fact, it was a senior oncologist, one of the best we have in our facility, one whose abilities and compassion I respect enormously. Apparently Dr. X had felt same call that I had. But apparently the call of nature wasn't the only call he had felt the need to answer.

"Of course I'd be happy to accept him here, if that's what you'd like. However, if you'd prefer to give him the chemo yourself, you could always transfer him if he got into trouble." A pause, during which I could hear a quiet buzzing that must have been the person he was talking to coming through on his phone. "Yes, I'd say the odds of inducing a remission are probably less than 50%, but he'll progress rapidly if you don't do anything, and even if you don't get a complete remission you could get a strong partial response."

Holy crap! (An appropriate exclamation, given the situation.) Dr. X was having a long and involved conversation on a cell phone about a patient with another physician while sitting on the throne! As I sat there, I could not help but become engrossed (another seemingly appropriate word) in the conversation. He was going into great details about this patient's course of treatment, the likelihood of success, the potential side effects, and how those side effects could be managed. I was getting a serious education in the second-line therapy for non-Hodgkin's lymphoma right there on the commode! At first I thought to myself that this had to be some sort of HIPAA privacy violation, but on second consideration, I realized that no patient-identifiable information was being discussed at this end. (Hopefully the doctor on the other end of the conversation was in his or her office or someplace suitably private.) The conversation was perfectly legal! So engrossed was I that I temporarily forgot my purpose in entering that stall. No problem, though. My colon wouldn't let me forget for long my original purpose.

I completed the task for which I had entered the stall.

Sweet relief, but I was now faced with a dilemma. Dr. X was still continuing his conversation next door, but my task was actually not yet quite complete. One thing remained. The problem is, I realized, that that "one thing" might cause a problem. So, there I stood, having finished wiping, and pondered the question for several seconds: Should I or shouldn't I flush? On the one hand, flushing would very likely be heard by the person on the other end of the line, revealing that Dr. X was in the bathroom while carrying out this conversation. I didn't want to embarrass him if I could help it. On the other hand, the end result of my visit to the commode was rather large and stinky, my having had a pretty big and greasy meal the night before. It really wasn't fair to future users to leave it there unflushed to pollute the rest of the public restroom. Dr. X had decided to have his conversation in the sanctum sanctorum. I couldn't be responsible. However, I could be responsible if I left the disgusting product of my colon behind, unflushed, to gross someone else out and to require them to do what I should have done in the first place. My course was clear. I knew what I had to do.

I hesitated a moment, my hand over the handle, and then flushed.

The sound filled the restroom, loud and reverberating off the walls. It was an unmistakable sound, an emphatic declaration that my business there had concluded. There was no way that Dr. X's conversation partner wouldn't have heard, as the phone couldn't have been more than five or six feet from the sound, separated only by a partition. The sound of rushing water seemed to go on forever. It's fortunate that it did go on so loudly and luxuriantly.

The flush covered my escape.

I darted out of the stall, went right past the sinks, left the restroom, and headed for my lab, where I could wash my hands without the chance of Dr. X seeing me on his way out, although I think he was still otherwise indisposed.

Gentle reader, you might wonder why I behaved in the manner that I did. I ask myself the same question. Why couldn't I have thought of another solution? For instance, I could have refrained from flushing and then simply checked back in a few minutes, after Dr. X had finished both parts of his business, the primary and secondary (I don't know which he would consider primary and which secondary). My office wasn't far away, nor was my laboratory. Such a solution would have worked quite well.

The answer, I think, comes down to annoyance, plus a little embarrassment at having listened in on a private conversation about a patient. Yes, I realize that the embarrassment was irrational, given that I had little choice but to hear the conversation (unless I wished to go to the public restroom one floor down, not a great idea given the urgency of my need), but the annoyance was not. It used to be that, even in a public restroom, one could expect a modicum of privacy to go about one's business with regard to the purpose for which the stall was intended. Little in the way of conversation usually happened there (the exception being large restrooms at stadiums, where people waiting in line will frequently talk), and even there usually not in the stalls. But I think the annoyance was more generalized than that. The younger readers of this blog may not understand this, but I was annoyed at the intrusion. I was annoyed that technology has reached the point such that no place is considered off-limits for conducting business or doing work, a point driven home by this incident.

No place, that is, except the rare locale that doesn't have a signal.

Don't get me wrong. Cell phones are wonderful devices, something so phenomenally and incredibly useful that I no longer see how I could go through life without one. I'm a complete gadget freak in many ways. However, back when I started my residency, pagers were used only by doctors and drug dealers. A few years later, anyone could afford them. A few years after that, cell phones proliferated. I got my first cell phone in 1997, and it was a brick and too expensive to use all that often. Now cell phones are tiny, and you can get plans with huge buckets of nationwide minutes at relatively cheap prices. No wonder almost everyone has one. No wonder Dr. X uses one to take care of business while he's taking care of business, so to speak, given how much he has to do in a day. However, thinking of being so busy that I would feel the need to occupy every minute with productive activity, including my time on the throne, would give me pause.

The great benefit of these devices is that they allow us to be connected almost anywhere, an attribute that is particularly useful in emergencies and especially useful for doctors who take care of a lot of sick patients. Unfortunately, that same interconnectedness is also their curse. For many, there is now no escape from work, no place that can be considered private, no excuse for not answering. For others, there is now no place that is safe from being subjected to the interconnectedness of others. Being subjected to a detailed conversation about a paitent while I was trying to take care of business that, until recently, had been considered private reminded me of that. Twenty years ago, no one would have conceived of having telephone conversations of great import while sitting on the can. Now, no one thinks anything of it. It's bad enough when someone as busy as Dr. X feels so harried that he won't even allow himself a moment's peace, but what about less important uses. I've seen guys walk into the restroom, phone plastered to their ear jabbering away, walk up to the urinal, whip it out, do their business, flush, and put it back in their pants, all without even slowing down their conversation.

Are all these conversations really so important that they can't wait a few minutes? To some extent I can understand why Dr. X, being so unrelentingly busy taking care of his patients, might consider it entirely rational to take advantage of a cell phone's ability to let him to do two things at once even in the strangest of places, but that doesn't mean I have to like it. Technology exists to serve, but unfortunately it's all too easy to let it rule us. All this wonderful technology that wires us and binds us through radio waves to each other can, at times, seem a smothering electronic cocoon that destroys the precious little personal space we have left.

24 example(s) of insolence returned:


At 5/23/2005 8:20 AM, Blogger Daniel said...

there is a blog called Postsecret which I recently stumbled across, one of the secrets posted for this week was "I take great pains to poop in private" :-)

 

At 5/23/2005 9:08 AM, Blogger OutEast said...

This brought to mind vague memories of an article I read some years ago about workaholics who, in the (gasp) pre-mobile daysa had phones installed in their toilets. (Not actually in the toilet, you understand...)

I thought I'd try and find som,ething through google... Unfortunately, this story caught my eye: http://edition.cnn.com/2003/TECH/ptech/10/31/offbeat.mobile.toilet.reut/

I got no further.

 

At 5/23/2005 9:12 AM, Anonymous Anonymous said...

The funniest thing I've overheard in a bathroom recently was "hold on for a minute, I've got to flush." And she was probably raised by humans. Amazing.

 

At 5/23/2005 11:34 AM, Blogger Mike the Mad Biologist said...

Orac,

people used to think LBJ was a rube because one of things he used to do on occassion was to have conversations with subordinates while on the can (usually through the door or by shouting around the corner while the door was open).

Now it seems he was just ahead of his time...

 

At 5/23/2005 12:21 PM, Anonymous Judy said...

So when does Dr. "X" catch up on his reading?

Never mind, I don't think I want to know.

This sort of thing is why my cell phone stays off and is therefore mostly a voice mail that I check when I'm not busy.

 

At 5/23/2005 12:31 PM, Blogger Dreaming again said...

Dr. Charles posted about cellphones last week ... it left me laughing in church Sunday when someone answered theirs and was talking (not whispering).

At least with that one, I was able to keep it at a quiet chuckle, the next inappropriate usage of cellphone use, I just may bust out laughing thanks to you!!

http://drcharles.blogspot.com/2005/05/crazy-people-seen-everywhere.html

 

At 5/23/2005 1:46 PM, Blogger Kelly said...

Loved the post! My favorite related story is when I have to call a certain neurologist XX (it's a woman-ha) at some horrific hour of the night and the caller ID on our hospital phone occasionally shows her boyfriend's name (another of our hospital's doctors). I always wonder what I was interrupting.

 

At 5/23/2005 1:50 PM, Anonymous The Cheerful Oncologist said...

Talk about multi-tasking! Trust me, I will never be caught speaking to a patient or doctor with my pants encircling my skinny ankles. Is life so absurd that one's own bowels are now a beloved part of our daily interaction with our peers?

My cheeks flush at the thought of such outrageous behavior!

 

At 5/23/2005 3:10 PM, Blogger Ereshkigal said...

I would have flushed twice.

Dr. X chose to breach the privacy of anyone else who wanted to use the bathroom for its intended purpose.

It's too bad that the "big and greasy meal" you ate the night before did not generate a lot of noisy flatulence. What appropriate background music that would have been for such a call.

 

At 5/23/2005 7:20 PM, Anonymous Trance said...

Wow. And I get irritated at people who won't get off the phone in the line at the grocery store--I can't even imagine what it would be like to hear that. I don't think I would have hesitated to flush, though I do feel some sympathy if that doctor really is working all the time. But is it really THAT necessary?

It seems to me that 1998 was the year these phones showed up everywhere. I graduated from undergrad in December 1997 and my school was relatively cell phone free, came to grad school in the fall of 1998, and all of the sudden they were everywhere. I refuse to get one. I'm not important enough to have one and I hope I never get that important.

 

At 5/23/2005 9:42 PM, Blogger Michelle said...

As Dr. Charles points out, crazy people are everywhere!

My craziest story on this topic is the student who opened the door to the ladies room to call, "I know you're in there, Dr. XYZ!"

I sent her out. Firmly.

 

At 5/23/2005 10:33 PM, Blogger Orac said...

Dr. Hildreth: I hesitate to ask which cheeks blush.

Ereshkigal: Actually my greasy meal did give me a case of flatulence, but unfortunately not at the time of the incident.

Kelly: Your story reminds me of when I was a resident. One of the attending surgeons was a well-known ladies' man. Unfortunately, he was married. He always told us never to call him at home, always to page him. I found out much later that the reason for this is because he used to tell his wife that he had to stay in the hospital when he was on call.

 

At 5/24/2005 5:04 PM, Blogger OBloodyHell said...

Doc, sorry to tell you this, but you're just old.

I'm no spring chicken, but I can see how this is not going to be unusual for anyone coming of age from the late 80s on.

Further, it is a natural outgrowth of human social purposes...

"Civilization advances by increasing the number of important things we can do without thinking about them"

This includes taking a dump. When you have to break off EVERYTHING more important to go pinch a loaf, you have a process which is interfering with those important things. The Onco in question was just not letting his elimination needs prevent him from doing things more important.

...And it IS more important. Think about it. Were you the patient being discussed -- clearly in serious trouble -- Would you prefer that he not have had time to get back with the colleague he was conferring to, and not advise the poor schnooks' doc on the best course of action? Honestly, that trumps your desire for privacy, surely, by any rational measure.

In the long run, this isn't going to be an issue. For a few decades we'll have cellphone tech to communicate with. Ever smaller, ever less intrusive (someone has a jacket, now, with a cellphone built into it... buttons on the sleeves). Sooner or later it'll be implanted into your body, with no external equipment required.

Next step is to bypass the need for actual sound. Tie into some nerve bundle and learn how to control it without speaking, and pump sound directly into the auditory nerve. Then your problem will be solved (but you may not last long enough to see it, I know) as people stop needing to be visibly dealing with a call to respond to one.

 

At 5/24/2005 6:36 PM, Blogger Orac said...

Ah, the strictly utilitarian argument for such behavior. I wondered if I'd see that one pop up. Sorry, but, important as the conversation might have been, it was clearly not emergent. It could have waited a few minutes with no harm to patient.

 

At 5/25/2005 4:20 PM, Anonymous Anonymous said...

So if there's no etiquette problem with talking on the can, there's no problem with someone else flushing, right?

 

At 5/25/2005 5:32 PM, Blogger Orac said...

The perfect rationalization for my behavior! Thank you.

 

At 5/26/2005 2:50 PM, Anonymous Anonymous said...

I concur with Anonymous @4:20. If the doctor on the cell phone expected silence in the background, he would not have chosen to continue the call while he was in the can. Flushing a toilet is something you have to do just because it's part of the process. Rescuing another man's dignity after he has thoughtlessly placed it in jeopardy is sweet but not something you need to get all heroic about.

 

At 5/26/2005 4:58 PM, Anonymous Anonymous said...

Reminds me of this joke I heard. A guy walks into a bar with his hand up to his face and ear talking into his palm. He sits down at the bar and finishes his conversation. The bartender walks over to take his order and asks, “Hey what kind of phone do you have? That must be a really small phone.” The guy shows him his hand and says, “It’s the latest technology. The phone is implanted in my hand. I don’t have to worry about losing it or breaking it or anything it is always right here with me.” As all the bartender saw was a normal looking hand he was fairly impressed. Guy orders his drink and heads to the bathroom. A few minutes later another patron comes up to the bartender and nervously says, “Hey there is something strange going on in the men’s room, I think you had better go check it out.” The bartender sighs and heads to the men’s room. Inside he finds phone implant guy on the floor with his pants down around his ankles and a whole lot of toilet paper stuffed up his butt shaking like he is having a seizure. The bartender says, “Dude are you OK?” Implant guy says, “Hold on, I’m getting a fax.”

 

At 5/27/2005 8:33 PM, Anonymous Anonymous said...

I think it's obvious that it was all about acoustics. In bathrooms, the echo is such that you can sound like the voice of God on the phone -- all the better for a consultant.

 

At 5/31/2005 10:44 PM, Blogger decrepitoldfool said...

I have always wondered how someone else's conversation in my earshot could violate my privacy. Disturb my peace and quiet, yes; but my privacy cannot be violated without information flowing outward.

When the typewriter was first invented some people were outraged at receiving business correspondence that was not written by hand. All new communication technologies change the way people interact.

His talking was a secondary purpose to the room, so your flushing takes precedence.

 

At 8/26/2005 11:12 PM, Anonymous Clay said...

I see this is an old post, but no matter, no one has mentioned that Dr. X must have received a consultation fee for his time and advice, which probably was passed on to the patient.

 

At 8/27/2005 10:21 AM, Blogger Orac said...

Probably not. This is academia, and a lot of services we render don't get billed. That is probably going to have to change if we wish to remain financially viable.

 

At 9/24/2005 11:56 AM, Blogger N said...

I headed towards the bathroom nearest my office, thankful that the urge hadn't hit me while I was in the operating room.

What do surgeons do when that happens? Hold it in or ask a colleague to take over for a while? Is it considered common? Courteous? Do the top-notch professional make it a point of pride not to poop mid-procedure?

Inquiring minds want to know.

 

At 10/01/2005 2:33 PM, Anonymous Frumious B. said...

I stayed in a hotel once, I cannot remember which, that had a phone installed right next to the toilet. All I could think was, can't people stop taking calls even for an instant? Is there nothing which cannot wait 5 minutes?

 

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